Delivering Value in Health Care
Presentation to Policy Leaders Academy
March 7, 2013
Richard W. Freeman, MD, MPH, FACP
Sr. Vice President & Chief Transformation Officer
rwfreeman@emhs.org
Market Dynamics: A Message From Maine’s
Employers…
“The state employee health plan covering 40,000 employees,
eligible dependents and retirees must achieve flat funding for
FY’12 and FY’13, with FY’11 as the base year.”
“In order to achieve flat funding for the current fiscal year, the
State Employee Health Commission introduced benefit
changes totaling $15 million. Nearly 80% of that amount was
the direct result of cost shifting to an employee population
that has not experienced a general salary increase in over
four years and a retiree population that has not received a
COLA adjustment in nearly four years. The commission
cannot rely so heavily on cost shifting in FY ‘13.”
~Frank A. Johnson/Letter from Nov. 1, 2011
2
2
Together We’re Stronger
Market Dynamics: The message from CMS
• An Accountable Care Organization will…
–
–
–
–
–
–
–
–
Put the beneficiary & family at the center of all its activities
Ensure coordination of care regardless of its time or place
Attend carefully to care transitions
Manage resources carefully and respectfully [reducing] dependence on
inpatient care
Be proactive, reaching out to patients with reminders and advice
Measure what it achieves for beneficiaries and communities over time
and use such data to improve care delivery and patient outcomes
Be innovative in the service of the three-part aim
Continually invest in the development and pride of its own workforce,
including affiliated clinicians
http://www.ofr.gov/ofrupload/ofrdata/2011-07880_pi.pdf
3
3
Together We’re Stronger
Accountable for Population Health Management
Focus activities based on person’s needs and risk for future healthcare costs
Distribution of Members by Claims Cost
60%
60%
50%
40%
40%
30%
20%
25%
18%
15%
% of Total Members
15%
12%
10%
% of Total $
7%
4%
2%
0%
1%
0%
1%
0%
No Cost
<$0.5
$0.5 - 4
$4-50
$50-100
$100-500
>$500
Total Claims Cost (000s)
15% of members =
60% of costs
80% of members =
20% of costs
Member Retention
Health Education & Preventive Care
DM Programs
Shared Decision Making
5% of members =
20% of costs
Case Management
Shared Decision Making
EMHS Care Systems
4
Together We’re Stronger
EMHS’s Pioneer ACO
5
Together We’re Stronger
Our Mission
The mission of Eastern Maine Healthcare
Systems is to maintain and improve the
health and well-being of the people of
Maine through a well-organized network
of local healthcare provider who together
offer high quality, cost-effective services
to their communities.
6
Together We’re Stronger
Early Responses to Market Dynamics
Early Stage – Foundation
Elements
Population Health Steps In
Progress…
Pioneer Model ACO (CMS)
Patient Centered Medical Homes
EMR / Patient Registries
Bangor Beacon Community
Grant: A new community of
practice with PCP-based Care
Coordinators
Accountable care contracts with
commercial health plans,
employer trusts
Network Partners
•
Aligned, non EMHS hospitals
Community Care Teams
•
Aligned FQHCs
EMHS Sustainability Planning
•
Community Organizations
Geisinger EMHS TPA
Partnership
NNEACC
7
Together We’re Stronger
But, it’s really about the Business Model…
•
•
•
Satisfy a real customer who needs a job done
Demonstrate how to fulfill this need at a profit
Compare that business model to your existing model to determine how
much you have to change it to capture the opportunity
“There is no point in going to a new business model unless it is
not only new to the company, but is in some way game-changing
to the industry or market.”
MW Johnson, CM Christensen, H Kagermann. “Reinventing Your
Business Model”, IN Rebuilding Your Business Model. Harvard
Business School Publishing Company, 2011
8
Together We’re Stronger
Some Resources
• Center for Health Care Strategies http://www.chcs.org/
• Colorado Regional Care Collaborative Organization
example http://www.coaccess-rcco.com/
• Colorado State Government accountable care website
http://www.colorado.gov/cs/Satellite/HCPF/HCPF/12337
59745246
• EMHS Difference in Care
http://www.emhs.org/Home/Beacon-Heatlh.aspx
9
Together We’re Stronger